Pill Pushing©

Bath salts - They aren't your mom's Calgon Beads - (7/1/2017)

By Dr. Ron Gasbarro

Society at the time

The year was 2010 and it seemed as if the world was spinning off its axis. Take that year’s deadly earthquakes as an example. In 2010, a 7.0-magnitude earthquake occurred in Haiti, devastating the nation's capital, Port-au-Prince. With a confirmed death toll over 316,000, it is the seventh deadliest on record. An 8.8-magnitude earthquake occurred in Chile, triggering a tsunami over the Pacific and killing at least 525. The earthquake is one of the strongest in recorded history.

A 7.1 magnitude earthquake rocked Christchurch, New Zealand causing large amounts of damage but no direct fatalities. It is the first in a cluster of earthquakes between 2010 and 2012 that resulted in the deaths of 187 people and over $40 billion worth of damage throughout the New Zealand islands. An earthquake and consequent tsunami off the coast of Sumatra, Indonesia, killed over 400 people and left hundreds missing. Repeated eruptions of Mount Merapi volcano in Central Java, Indonesia, and accompanying pyroclastic flows of scalding gas, pumice, and volcanic ash descending the erupting volcano killed 300 people and forced hundreds of thousands of residents to evacuate. In financial news, the 2010 Flash Crash, a trillion-dollar stock market crash, occurred over 36 minutes, initiated by a series of automated trading programs in a feedback loop. And in 2010, bath salts became available in head shops, gas stations, and porno palaces, creating a major health crisis in the US and the world, causing each user to spin off his or her axis.   

The drugs in question – Bath salts 
Synthetic cathinones, more commonly known as "bath salts," are synthetic drugs chemically related to cathinone, a stimulant found in the khat plant. Khat is a shrub grown in East Africa and southern Arabia; people chew its leaves for their mild stimulant effects. Synthetic variants of cathinone – such as synthetic bath salts – can be much stronger than the natural product and, in some cases, very dangerous [Baumann, 2014].

Synthetic cathinones are included in a group of drugs called "new psychoactive substances" (NPS). NPS are unregulated psychoactive (mind-altering) substances that have become available on the market and are intended to copy the effects of illegal drugs [Marusich, 2014]. Some of these substances may have been around for years but have reentered the market in altered chemical forms and due to renewed popularity. 

Chemically, cathinones are similar to amphetamines and to MDMA (Ecstasy or Molly) [Gunderson, 2013]. Common cathinones found in bath salts include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone (Drone, Meph, or Meow Meow), and methylone, but there are many others. Bath salts are usually a white or brown crystal-like powder and are sold in small plastic or foil packages labeled “Not for

Human Consumption.” Sometimes labeled as “plant food”—or, more recently, as “jewelry cleaner” or “phone screen cleaner”—they are sold online and in drug product stores. These names or descriptions have nothing to do with the product. It’s a way for the drug makers to avoid detection by the Drug Enforcement Administration or local police.

Bath salt street names 
Bath Salts manufacturers create many names for their products to attract as many customers as possible. Some of these names include:

  • Arctic Blast
  • Aura
  • Avalance or Avalanche
  • Bliss
  • Blizzard
  • Bloom
  • Blue Silk
  • Bolivian Bath
  • Cloud 9
  • Cotton Cloud
  • Drone
  • Dynamite or Dynamite Plus
  • Euphoria
  • Glow Stick
  • Hurricane Charlie
  • Ivory Snow
  • Ivory Wave or IvoryWaveUltra
  • Lunar Wave
  • Mexxy
  • Mind Charge or Mino Charge
  • Monkey Dust
  • Mystic
  • Natural Energy Powder
  • Ocean Snow
  • Purple Wave
  • Quick Silver
  • Recharge
  • Red Dawn
  • Red Dove
  • Rock On
  • Rocky Mountain High
  • Route 69
  • Sandman Party Powder
  • Scarface
  • Sextasy
  • Shock Wave
  • Snow Day
  • Snow Leopard
  • Speed Freak Miracle
  • Stardust
  • Super Coke
  • Tranquility
  • UP Energizing or Supercharged
  • Vanilla Sky
  • White Burn
  • White China
  • White Dove
  • White Lightning
  • White Rush
  • White Sands
  • Wicked X or XX
  • Zoom



The man-made cathinone products sold as “bath salts” should not be confused with products such as Epsom salts (the original bath salts) that people add to bathwater to help ease stress and relax muscles. Epsom salts are made of a mineral mixture of magnesium and sulfate.

Am I high yet?
According to the National Institute on Drug Abuse for Teens (teens.drugabuse.gov), use of bath salt drugs can cause severe intoxication (a person seems very drunk or “out of it”) and risky health effects. There are reports of people becoming psychotic (i.e., losing touch with reality) and violent. Although it is rare, several cases have been reported in which bath salts have been the direct cause of death. In addition, people who believe they are taking drugs such as MDMA (Molly or Ecstasy) may be getting bath salts instead [Anizan, 2016]. Methylone, a common chemical in bath salts, has been substituted for MDMA in capsules and sold as Molly or Ecstasy in some areas.

Bath salts can be swallowed, snorted through the nose, inhaled, or injected with a needle. Users have reported snorting or injecting it, or mixing it with food or drink. This can include “bombing” it (swallowing it wrapped in cigarette paper), taking it rectally, inhaling it using a vaporizer or smoking it. Snorting or injecting is the most harmful. 

The good, the bad, and the ugly

First off, there is no “good” in bath salts. Just the “bad” and the “ugly.” 

Bath salt addiction statistics
According to Lighthouse Recovery Institute, MDPV (3,4-methylenedioxypyrovalerone) has been found to raise dopamine levels in the brain 10 times higher than cocaine.
According to a report issued by SAMHSA (the Substance Abuse and Mental Health Services Administration), synthetic cathinones were responsible for over 22,000 ER visits in 2011.
According to the American Association of Poison Control Centers, in the final six months of 2011, there were over 3,400 cathinone related calls.
In 2012, this number dropped to 2,691.
In 2013, this number dropped to 996.
Perhaps the declining number of poison control center calls is due to Operation Log Jam. This was a 2012 US government operation in which 109 cities were raided, 91 people arrested, and 167,000 bags of synthetic cathinones seized. 
As of late 2016, over 150 new types of synthetic cathinones were identified.

Are synthetic cathinones addictive?
Yes, synthetic cathinones can be addictive. Animal studies show that rats will compulsively self-administer synthetic cathinones. Human users have reported that the drugs trigger intense cravings—uncontrollable urges to use the drug again. Taking synthetic cathinones often may cause strong withdrawal symptoms that include:
Depression
Anxiety
Tremors
Problems sleeping
Paranoia

Bath salts: long-term effects
The harm caused by bath salts can be long-term and permanent, including:
Increased blood pressure and heart rate
Kidney damage and failure
Liver damage
Breakdown of skeletal muscle tissue
Brain swelling and brain death
Death
A 2013 study found that MDPV was highly addictive—possibly more so even than methamphetamine, one of the most addictive drugs in existence [Aarde, 2013]. Bath salts were linked to nearly 23,000 emergency department visits in the United States in 2011 [SAMSHA, 2013]. Another study in the Midwestern US found that more than 16% of patients sent to hospital emergency rooms due to bath salt abuse were in critical condition or died [ACEP, 2013]. The adverse effects of MDPV can last as many as 6 to 8 hours after use; it has been reported to cause prolonged panic attacks, psychosis, and deaths.

Impact on society 

The use of bath salts has resulted in some of the most bizarre behavior ever seen in the US. 

The naked and the dead 
People on bath salts have been running around naked and committing crimes! A strange phenomenon for sure, and it has been trending around the world online. Police caught on to the trend following a naked crime wave outbreak in Arizona that has since spread across the United States and even to Canada. Addiction specialists have since pinpointed bath salts as the cause. Mephedrone, one of the active ingredients in bath salts, makes users feel confident and energized and enhance musical experiences. However, it can also cause serious rage, severe confusion, hallucinations, and abnormally high body temperatures. 

A run-down of actual bath salt-associated crimes and deaths
The naked man who ate the face of a homeless Miami man. The man was fittingly described as "zombie-like."
The Florida woman who exposed her breasts, vagina, and buttocks while standing in the middle of an intersection in Broward County. According to police, she did not "give a f---" about her actions.
The half-naked Miami man who introduced himself to a 3-year-old girl at a playground by saying, disturbingly, that he wanted to "stick it in" her. Before police arrived, he hid under a slide and disturbed one other family with his actions.
The naked Munnsville, New York woman who strangled her dog and punched and choked her child. Before she did any more damage, police arrived and tasered her, which later resulted in her death.
The half-naked man at a golf course in Georgia who threatened to eat the police. In this very strange account, the accused had super-human strength and a number of officers had to hold him down while tasering him 14 times, all the while he was screaming about how he wanted to eat them.
The woman from Texas who crashed her car, stripped, and then made a stop at a Houston ice cream shop. 
The naked man from Illinois who thought he could go surfing on the hood of a moving car.
The naked woman who started a hospital fight in Pennsylvania.
The Miami man who broke into a house, stripped, threw some furniture around, and then bit the man who lived there. This is yet another case of what seems to be becoming a bath salt zombie apocalypse.
The naked man who decided to illegally skinny dip in Tempe Town Lake in Phoenix, Arizona. He would quickly swim away from officials every time they got close but eventually was caught.
The naked New York woman who tried to eat a police officer (hmm, being hungry for police officers seems to be becoming a trend…).
The naked Calgary man who was discovered smashing his head into a fence. 
The naked carjacking criminal from Scottsdale, Arizona, who crawled onto his car's roof and started singing after causing multiple accidents. 
The California man who began dry humping the air in public while in the nude and shouting about how he had found God.
The man who was driving and then crashed his rental moving truck into a house while he had no pants on. He fled the scene and ran home, but police found his wallet in the pair of pants he had left in the truck.

Where the drugs are today

At the end of the last decade, bath salts began to gain in popularity as “legal highs.” In October 2011, the Drug Enforcement Administration put an emergency ban on three common man-made cathinones until officials knew more about them. In July 2012, President Barack Obama signed legislation permanently banning two of them—mephedrone and MDPV, along with several other man-made drugs often sold as marijuana substitutes, such as Spice.


Although the law also bans c
hemically similar versions of the named drugs, manufacturers have responded by making new drugs chemically different enough from the banned substances to circumvent the law.


How can people 
get treatment for addiction to synthetic cathinones?

Behavioral therapy may be used to treat addiction to synthetic cathinones. Examples include:
Cognitive-behavioral therapy
Contingency management, or motivational incentives—providing rewards to patients who remain substance-free
Motivational enhancement therapy
Behavioral treatments geared specifically to teens
No medications are cu
rrently available to treat addiction to synthetic cathinones.


Testimonies from the front lines 

“This product is poison… After the first hour, I started to feel the cocaine-ish comedown that grew increasingly worse. The left side of my chest began to tighten and my heart was beating faster than ever… Paranoia set in… I was very close to requesting hospital treatment, but I waited it out. I would get better, a little worse, back and forth, but eventually, after 3 to 4 hours, I was feeling thankful to be alive and sober… The reports of people dying, or going to the hospital ARE NOT BULL***T… This is a dangerous poison that some scum is making cash off of in the most evil of ways.” —G.F.

“Do not use this stuff. My heart stopped beating. I am an experienced drug user who experimented with more drugs than I have fingers. [Bath Salts] are more dangerous than crack. The comedown was the worst experience of my life. It lasted 9 hours. Nothing but fear, heart palpitations, jitters, severe nausea, and everything coming and going a million miles an hour. It was terrible. Because of this experience, I will never use drugs again. I am lucky to still be alive to warn you. STAY THE HELL AWAY FROM THIS …” —E.W.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com

References 
Aarde SM, Huang PK, Creehan KM, Dickerson TJ, Taffe MA. The novel recreational drug 3,4-methylenedioxypyrovalerone (MDPV) is a potent psychomotor stimulant: self-administration and locomotor activity in rats. Neuropharmacology. 2013;71:130-40.

American College of Emergency Physicians (ACEP). “These aren’t your grandma’s bath salts.” March 28, 2013. Available at: http://newsroom.acep.org/2013-03-28-These-Arent-Your-Grandmas-Bath-Salts  

Anizan S, Concheiro M, Lehner KR, et al. Linear pharmacokinetics of 3,4-methylenedioxypyrovalerone (MDPV) and its metabolites in the rat: relationship to pharmacodynamic effects. Addict Biol. 2016;21:339-47. 

Baumann MH, Solis E Jr, Watterson LR, Marusich JA, Fantegrossi WE, Wiley JL. Baths salts, spice, and related designer drugs: the science behind the headlines. J Neurosci. 2014;34:15150-8.

Gunderson EW, Kirkpatrick MG, Willing LM, Holstege CP. Substituted cathinone products: a new trend in "bath salts" and other designer stimulant drug use. J Addict Med. 2013;7:153-62.

Marusich JA, Antonazzo KR, Wiley JL, Blough BE, Partilla JS, Baumann MH. Pharmacology of novel synthetic stimulants structurally related to the "bath salts" constituent 3,4-methylenedioxypyrovalerone (MDPV). Neuropharmacology. 2014;87:206-13.

US Substance Abuse and Mental Health Services Administration (SAMHSA). “Bath Salts” were involved in over 20,000 drug-related emergency department visits in 2011. The DAWN Report; September 17, 2013. Available at: https://www.samhsa.gov/data/sites/default/files/spot117-bath-salts-2013/spot117-bath-salts-2013.pdf

Other sources: US National Institute on Drug Abuse and US Office of National Drug Control Policy.

 


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